From Jan. 1, 1990 to Dec. 30, 1994, 38 patients with mammary duct ectasia admited to our hospital, for whom the diagnoses were confirmed by pathological examination of surgical specimens. Intensive literature review was made together with 569 cases of this group were summarized in terms of clinical features of the disease. Tumor-like mass is a most common sign (78.21%), and the other clinical features are: nipple discharge (28.47%), nipple retraction (21.79%), axillary node enlargement (15.82%), skin adhesion (11.25%) and breast fistula (3.87%). Surgical excision of the mass is the unique effective treatment of chioce. 24 out of 38 cases were misdiagnosed other than mammary duct ectasia. Careful clinical observation and examination may reduce the chance of misdiagnosis.
Objective To find a more perfect method of treating developmental dislocation of the hip(DDH). Methods From March 1994 toDecember 2002, on the basis of the ordinary operative method, Pemberton method was improved for 48 cases of DDH 49 articulatio coxae which had superficial and small acetabula but bigheads of femur. Osteotomy points were moved higher to enlarge area of bone flapturned over. A piece of full thickness ilium including periosteum was removed as a free bony graft. Capsula articularis growing thicker was made into 2 layers, of which the inner layer was used to tighten articularis and the outer layerwas used to stabilize bone flap. Results All patients were followed up for 18 months to 5 years, the function of articulatio coxae and degree of bony union, inclusion area to head of femur and ischemic necrosis of femoral head were observed through X-ray. According to Zhou Yongde’s criteria for the curative effect of congenital dislocation of the hip, there were 18 cases of 26-30 scores(3 hips), 27 cases of 21-25 scores, 2 cases of 1620 scores(3 hips), and 1 case under 15 scores, and the total superior ratewas 93.8%. Conclusion Improved Pemberton method can enlarge inclusion area tohead of femur, avoid decreasing acetabular volume, and stabilize articulatio well, which made operative indication bigger than original Pemberton method.
Five thousands five hundreds and eighty two patients with cholelithasis in 46 hospitals were collected through questionnaire and analysed, of which 2 735 cases were gallstones (accounted for 48.99%),and 2 847 cases were intraand extrahepatobiliary tract stones (accounted for 51.00%). In the gallstone group, there were 487 cases (8.72%) complicated with choledocholithasis, 54 cases (1.97%) complicated with acute cholecystitis, 189 cases (6.91%) with acute cholangitis, and 215 cases (7.86%) with obstructive jaundice. In 2 847 cases with intra and extrahepatobiliary tract stones, 1 284 cases were found to be extrahepatic duct stones (23.00%), 668 cases were left intrahepatic duct stones (1.97%), 384 cases were right intrahepatic duct stones (6.88%), and 511 cases stone in both sides (9.15%); complications in this group were acute severe cholangitis 683 cases (23.99%), acute cholangitis 1 169 cases (41.06%), obstructive jaundice 431 cases (15.14%), and biliary cirrbosis 278 cases (9.76%). The operative procedure for patients with gallstones were cholecystectomy (2 697 cases), chelangioduodenostomy or cholangiojejunostomy (36 cases), and Oddi’s sphincteroplasty (7 cases); and for patients with intraand extrahepatobiliary tract stones were choledocholithotomy and T tubule drainage (2 275 cases), differecnt forms of choledochoenterostomy (534 cases), and Oddi’s sphincteroplasty (38 cases). The postoperative complicatioin rate in patients with gallstones was 1.13%, with intraand extrahepatobiiary tract stones was 14.47%, mortality of the latter was 1.62%. The authors consider that cholecystectomy should be performed in elderly patients (over 50 years) with or without symptoms, and proper choice of operative procedure for hepatobiliary tract stones is important.
OBJECTIVE To observe the effects of sodium hyaluronate on nerve root adhesion after operation of lumbar disc protrusion (LDP). METHODS From April 1996 to June 2001, 152 cases with LDP were performed the removal of nucleus pulposus under endoscope. After operation, 2 ml of sodium hyaluronate were injected. The clinical results were evaluated by clinical symptom, straight leg raising test, patient’s satisfaction degree and back pain. RESULTS All the patients were followed for 1 month to 3 years. The average angle of straight leg raising test increased from 26 degree preoperatively to 62 degree postoperatively. The patient’s pain were markedly relieved. Patient’s satisfactory degree were 86.8%. CONCLUSION The injection of sodium hyaluronate after operation of LDP has effect on preventing postoperative nerve root adhesion.
Objective To explore the safety, effectiveness, operation mode and clinical value of the laparoscopic colorectal resection. Methods The clinical data and experiences of laparoscopic resection for 18 cases with colorectal neoplasm from Jun. 2007 to Mar. 2008 were studied retrospectively. Results Among 18 cases, there were 5 cases of rectal cancer, 6 cases of sigmoid colon carcinoma, 2 cases of sigmoid colonic polyp, 2 cases of descending colon carcinoma, 2 cases of ascending colon carcinoma and 1 case of ascending colonic lipoma. Fifteen cases of laparoscopic colorectal resection were performed successfully, including Dixon procedure 4 cases, Miles operation 1 case, radical resection of sigmoid colon 5 cases, palliative resection of sigmoid colon 2 cases, left hemicolectomy 2 cases and right hemicolectomy 1 case. Three cases converted to laparotomy due to adiposity or advanced status of local disease. Average intraoperative blood loss was 110 ml. The average number of lymph nodes dissected was 13.5. It took about 40 hours to restore intestinal function. The average time of hospitalization was 9 days. No one died during operation and no complications such as anastomotic leakage and postoperative hemorrhage occurred. Conclusion Laparoscopic resection for colorectal neoplasms possesses less trauma and rapid postoperative recovery. Laparoscopic colorectal surgery is safe and effective with skill and indication.
Objective To explore surgical technique and clinical outcome of transabdominal preperitoneal hernia repair (TAPP) and totally extraperitoneal hernia repair (TEP) in inguinal hernia repair. Methods 〗The clinical data of 23 patients underwent laparoscopic herniorrhaphy were retrospectively analyzed. Nine patients were underwent TAPP, and 14 patients underwent TEP. Results 〗None of patients was changed to open operation. Only one patient of TEP was changed to TAPP. Average operative time was (82.1±40.6) min. Blood loss was (5.7±3.0) ml. Disruption of peritoneum happened to 2 patients underwent TEP. The rate of postoperative complications was 21.7% (5/23), which included serum swelling (1 case), scrotal emphysema (2 cases), transient neurapraxia in the area of repair (1 case) and urinary retention (1 case). No chronic pain, foreign body sensation and infection were found. Average hospitalization after operation was (4.3±0.9) d. No recurrence was observed during a follow-up period of 1-15 months. Conclusion 〗Laparoscope herniorrhaphy is safe due to lower recurrence and complications. It also has the advantages of slight pain and rapid recovery.
Objective To compare the clinical effect between neo-adjuvant chemotherapy combined with operation and simple operation under multi-disciplinary team in rectal cancer. Methods A survey of 72 patients with rectal cancer from Nov. 2007 to Mar. 2008 were studied. Patients were divided into two groups using a simple random method: 33 cases in combined therapy group were treated with single period neo-adjuvant chemotherapy as well as operation and 39 cases in control group received operation only. To compare the differences of perioperative period indexes between two groups. Results During the differences of indexes of age, gender, differentiation degree, clinicopathologic stage as well as the distance to dentate line of tumor, there was no statistical significance between combined therapy group and control group (Pgt;0.05). And at the same time, the operative type, operative time and bleeding quantity in operation had no statistically significant difference between two groups (Pgt;0.05). As for the postoperative rehabilitation indexes, the time of vent to normal in combined therapy group was earlier than that in control group, but the intake time was later than that in control group （Plt;0.05）. Falling range from preoperative CEA to postoperative CEA was larger in combined therapy group than that in control group （Plt;0.05）; and the falling range from preoperative WBC to postoperative WBC had no significant difference between two groups （Pgt;0.05）. Conclusion The clinical effect of combined therapy is obviously superior to simple operation, suggesting that neo-adjuvant chemotherapy combined with operation is feasible and safe.
Objective To evaluate different clinical effects of three inflow occlusion methods in hepatectomy including pringle maneuver （Pringle group），selective portal venous exclusion （SPVE group）， and Glissonean pedicle exclusion （SGSE group）. Methods The clinical data of patients underwent the liver resection with the above liver inflow occlusion methods were retrospectively analyzed. The operation time， inflow occlusion time， amount of intraop-erative blood loss， transfusion rate， and postoperative hepatic function and complication rate were compared for each group. Results There were not significant difference of preoperative conditions，operation time， inflow occlusion time，tumor character， postoperative liver function， hospital time，and ICU time （P＞0.05）. The amount of intraoperative blood loss and rate of blood transfusion of SGSE group were significantly less （lower） than those Pringle group and SPVEgroup （P＜0.05）. In addition to the first day after operation， the AST and ALT at other time point of SPVE group and SGSE group were improved than that Pringle group （P＜0.05）， while TBIL at the third and fifth day after operation ofPringle group were improved （P＜0.05）. The complication rates of SPVE group and SGSE group were significantly lowerthan that of Pringle group （P＜0.05）. Conclusions In the similar operatin time and inflow occlusion time，Glissonean pedicle exclusion method can control the intraoperative blood loss and blood transfusion better，and can promote the patientrecovery. Besides， the inflow occlusion methods should be selected based on the practical condition of patients.
Objective To enhance survival rate and treatment effect for advanced gallbladder cancer (GBC). MethodsEighty cases of advanced GBC were treated surgically from January 1990 to June 2001.Seventyone cases had obstructive jaundice, 15 had palpable abdominal mass. Extended radical cholecystectomy was performed in 39 cases of advanced GBC in which the tumor invaded the surrounding organs or tissues but without distant metastasis. ResultsFollowup showed that the survival period was between 8 and 37 months (average 18.1 months), 1， 2 and 3year survival rates were 43.6%， 20.5% and 5.1% respectively. Palliative operations were performed in other 41 advanced GBC cases with distant metastasis. All of the patients died within one year. Conclusion This result suggests that extended radical cholecystectomy is effective for advanced GBC.
ObjectiveAnalyzing the seizure and cognitive outcome after different treatment by observation of a large group of intractable child epilepsy patients under 15 years old.
MethodsCollecting data of children with Intractable epilepsy from Apirl 2008 to December 2013 in Sanbo Brain Hospital, Capital Medical University. Three historical cohorts of intractable child epilepsy defined by the final treatment including medication, curative operation and palliative operation depending on the surgical assessment and the families intension was retrospectively observed. 1 year and 3 years follow-up postoperatively were conducted including seizure outcome and cognitive outcome.
ResultsThe curative operation group had significant better seizure free rate, and cognitive statement than medication group. And, the seizure free and cognitive outcome were better in palliative operation group than the medication group.
ConclusionsEarly surgical intervention is highly recommended for intractable epilepsy chilelren in order to improve both the seizure and cognitive prognosis.
